Gram negative shock

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  1. Predominantly caused by endotoxin of polysaccharisde membrane on Gram negative organism – tumor necrosis factor (TNF) is the major mediator of host response to endotoxic shock and induces production of IL-1 by monocytes and endothelial cells (IL-6 and 8 are also involved in this reaction) – arachidonic acid metabolites such as leukotriene increase endothelial permeability and are chemotactic for neutrophils
    1. most common source is genitourinary system followed by the respiratory system
    2. typical organisms = E. coli, Klebsiella, Proteus, Serratia, Citrobacter, Enterobacter, H. Flu
    3. antibiotics: broad spectrum – metronidazole + ceftazidime
  2. clinically heralded by fever, chills, altered organ function and hypotension
  3. Treatment: fluids, antibiotics, find source; use norepinephrine, dopamine, vasopressine if patient develops hypotension unresponsive to fluids
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